Over-the-Counter Birth Control Pills: What You Need to Know

The U.S. Food and Drug Administration approved the first daily oral contraceptive for over-the-counter use, giving people more options for nonprescription birth control. Over-the-counter birth control allows people to take control of their own reproductive health and removes barriers to care, such as lack of health insurance or difficulties obtaining a prescription. Opill (norgestrel) was approved in July of 2023 and is available in pharmacies, grocery stores, and online retailers around the country.

As daily oral contraceptives are generally considered to be safe, over-the-counter birth control options empower the person by eliminating the need to visit a health care provider first. Opill was particularly lauded for its easy-to-read label, which was shown to help consumers understand the instructions and properly take the pill. Because of this, users are not required to see a healthcare provider, have an examination, or obtain a prescription, which offers convenience, safety, and autonomy to the person. However, you should understand how over-the-counter birth control works, what potential side effects are, and whether or not it will affect prior medical conditions or medications before starting it.

Why Take Over-The-Counter Birth Control?

Opill is an over-the-counter birth control pill that prevents pregnancy in 98% of cases and begins to work within 48 hours. Taken once a day in a 0.075 mg dose, Opill contains only progestin, which may be helpful to those who cannot take combination pills containing estrogen, such as those with a family or personal history of cancer, heart disease, stroke, or other conditions.

However, over-the-counter daily birth control is not meant to be an emergency contraceptive, meaning that it will not stop or prevent pregnancy after unprotected sex. Additionally, oral contraceptives will not prevent sexually transmitted diseases (STDs), including HIV, AIDs, chlamydia, and others.

In order for it to have the best chance of working, Opill should be taken at the same time every day, just like prescription oral contraceptives. Some medications interact with Opill and reduce its effectiveness, including those taken for seizures, HIV/AIDS, tuberculosis, and pulmonary hypertension, as well as herbal products like St. John’s wort. You should talk to your doctor before taking any new medications or supplements that might interact with others you’re currently taking.

Is Over-the-Counter Birth Control Right for Me?

There are a variety of oral contraceptives and other contraceptive methods available, all with their own benefits and drawbacks, depending on your needs and desired outcomes. While Opill is safe and usually well tolerated, taking it with certain conditions has added risks.

Those who should not use Opill include:

• Those who previously had or currently have breast cancer
• Those who have other forms of cancer should check with their healthcare provider
• Those who are using other forms of hormonal birth control, including a contraceptive tablet, patch, implant, injection, or an IUD
• Those who are already pregnant or think they may be
• Those who have vaginal bleeding between periods and have not sought advice from a healthcare provider
• Those who have liver tumors or liver disease

Additionally, a progestin-only pill like Opill may not be best for you if you are not able to take it at the same time each day, which is critical for it to be effective.

However, Opill may be a great choice if you:

• Have trouble accessing a prescription for birth control
• Would like your fertility to return quickly after stopping birth control
• Are breastfeeding
• Have increased risk of blot clots in the legs or lungs
• Have high blood pressure
• Are concerned about side effects from pills containing estrogen

What are the Side Effects of Over-the-Counter Birth Control?

Opill has several common side effects, including:

• Irregular bleeding
• Headaches
• Dizziness
• Nausea
• Increased appetite
• Abdominal pain
• Cramps
• Bloating

Consult with your doctor if you experience:

• Vaginal bleeding after sex
• Prolonged bleeding
• Missed periods

If you suspect you are pregnant or discover you are pregnant, stop taking oral contraceptives immediately. You should also discontinue use if you miss a single period after missing a few doses of oral contraceptives, until you can confirm your pregnancy status.

Making Your Birth Control Choice

While an advantage of having access to over-the-counter birth control is that you do not need to see a healthcare provider or have an examination, that doesn’t mean you should avoid going to the doctor or leave them out of the process. By letting your provider know that you are interested in contraceptives, you are helping them give you the best care possible, and they can even help you choose the best birth control for you based on your own unique circumstances—whether that is over-the-counter birth control or something else. You should also continue to schedule visits with your OB/GYN for preventative care and any family planning needs you may have.

“Opill will add to the contraception options available to patients over-the-counter without a prescription, such as condoms and spermicides,” says David Kattan, MD, MPH, Section Head, Family Planning. “It represents an advance for individuals who don’t wish to visit a health provider’s office to start birth control or face a delay in doing so. The Baystate OB/GYN department's team of providers is happy to discuss contraception options with any interested patients.”

If you have questions regarding over-the-counter or prescription contraceptives, or your overall reproductive and sexual health, talk to your primary care provider or OB/GYN.